Sinus Bradycardia and hypotension with clinical presyncope

[John2004]

Male, 42 years, 5'11", 188 lbs.  Stopped smoking 3 years ago, drink lightly, 0-3/day, light sports (golf), BP 140/100.

Last week driving my car I got a cold sweat, and felt I was about to faint. No apparent reason.  I've had this before, first time was when I was still a teenager in school, and over the years it has happend maybe 4-5 times in total.

My doctor suggested a tilt-table test and while doing this I passed out. The diagnose was: "Sinus Bradycardia and hypotension with clinical presyncope at the second stage of isomack spray and returned to the baseline 6 minutes after resting stage.".

The doctor explained to me something about my parasympatetic system "overreacting" but due to language difference (I'm not in US) I didn't really understand. The doctor prescribed Concor (Bisoprolol fumarate) 2.5 mg once daily.

1) I see Sinus Bradycardia defined as slow heartbeat. It seems to be more of an observation than a diagnose, right?
2) I though presyncope was "almost fainted". I definitely was out cold, I even remembered "dreaming" while out. Shouldn't it have been syncope?
3) Concor does wonder to my BP (now 130/80) but as a beta blocker I don't understand how this can help me from fainting.
4) Though I haven't had any fainting episodes since, I still feel a little dizzy and nauseus. Will this disappear?
5) Any better explanation of what's wrong with me?

[Cleveland Clinic]

Hi John,

Thanks for the post.

You most likely have vasovagal syncope from the details you provide.  To try to simply explain it, you body has a hard time adjusting to changes in the venous return that decreases when you stand.  People have a different responses to the tilt table, some have a slow heart rate, some a fast and some do not change.  This most likely is a peoblem related to your autonomic nervous system which helps control the tone on the vessels and the heart rate changes in response to the amount of blood that fills the heart.


1) I see Sinus Bradycardia defined as slow heartbeat. It seems to be more of an observation than a diagnose, right?

yes.  But it is important as there are different responses to people on the tilt table.  Unfortunately it is not simply the change in heart rate that causes your symptoms.

2) I though presyncope was "almost fainted". I definitely was out cold, I even remembered "dreaming" while out. Shouldn't it have been syncope?

These are details that do not really matter as long as the symptoms were recreated. However, syncope does refer to a complete loss of consciouness.  If you remember being out...you werent really out.

3) Concor does wonder to my BP (now 130/80) but as a beta blocker I don't understand how this can help me from fainting.

There are different thought to the mechanisms involved in POTS. Likewise, there are multiple different treatment modalities. The use of beta blockers are thought to compensate for an overactive autonomic nervous system. They work in some and not others.  

4) Though I haven't had any fainting episodes since, I still feel a little dizzy and nauseus. Will this disappear?

Hopefully. Only time will tell.  Make sure you document your symptoms and discuss with your physician as he/she tries to adjust your medications.

5) Any better explanation of what's wrong with me?

I hope that I just did!


good luck

[I'mallheart]

Hello, I know this is somewhat off topic, however, in over a year of trying, I've never been able to get a question out. Anyway, to my question.

When I was around 11, while jumping off a wall, I had a feeling like my heart dropped into my stomach and it began beating fast. At the time I had no clue, and after about 20 minutes it slowed down to normal instantly. This happened again around 12, and again at about age 14. When it happened at 14, I was taken to the ER and they placed me in a holster. Nothing abnormal was noticed, however, they did an ultrasound on my heart, and said all my valves were normal etc. This never really bothered me, in fact I thought it was kinda fun to show other people how fast my heart was beating. Until, I was playing baseball and it happened again around 15. I nearly passed out and was so freaked out I pulled myself out of the game. About a year or so passed and I started having something else. I guess they are called PVC's? I thought they were a result of having gas, but they would happen a lot when I drank soda. I didn't have a episode of SVT again, however, until I was 17. This time, I had 2 SVT episodes within 2 weeks. Regardless of this, I joined the Army, and for the next 5 years, not a SINGLE case of SVT, and my PVC's were almost non existant, except after exercise as I was calming down, I'd have one or two here and there.

Now to my main question, I joined the militar at 18, had around 7 episodes of SVT between age 11-18, with PVC's starting around age 16. Then, while joining the Army, nothing for the 3 years I served on active duty, except a minor PVC here and there after a run. After I left the Army, I didn't have any problems at all for the next 2 years. Then, the PVC's started again, only worse. Sometimes I'd sit and count them per minute and would reach nearly 30 in 1 minute. My resting HR was always around 70, so you can imagine how freaky that is. Then, at age 23, I had my first episode of SVT in over 5 years, the nurse at my work, couldn't even guess at my pulse, but my BP was 140/80 and as I calmed myself down it stopped. A week later, it happened again. For the next year after those episodes, I would have entire weeks of just PVC after PVC, to the point I was afraid to even do anything, as I would stop whenever it happened, and when they'd come 3-4 in a row, I'd totally shut down and go inside. Then, last month, just over a year since the last 2 episodes happened, the SVT happened again, but it stopped really quickly, about 10 minutes. I had been reading these boards since the first set happened since leaving the Army, so I stayed calm and it went fast. Then, one day at work, I was having really bad PVC's, and I stood up, and BOOM, there goes my heart. Not only did I have SVT, but the PVC's were there as well, which put me into a panic. It had never lasted this long before, and finally I went to the ER. When they found out it had been nearly an hour and a half that my heart was in SVT, with a HR of 220, they gave me some injection which felt like I was having a heart attack. A few minutes afterwards my HR was down to 110, and I was released.

Wow, this is long, I'am very sorry, but I wanted to detail everything.....Anyway, I'm trying to start running again, and getting back into good shape, but the PVC's happen at rest....while running its nearly unbearable...I'm seriously afraid my heart will stop, or in my opinion anyway, go into SVT while running. On the other hand, the only time my heart didn't have these problems was while I was in good cardio shape....I don't know if that was just luck? Or it that has anything to do with this or not, however, I'm to the point now...24 years old, that i'd rather go out and have a freakin heart attack then sit at my house afraid to play with my kids. Ablation is pretty much out of the question for me, as I have no health insurance at the time, but I just can't take this **** of a life this has left me with. My wife doesn't understand, and she acts like I make this stuff up. Hell, she was mad at me for costing us 2,000 for the ER visit.

So...has anyone had anything similiar happen with a high rate of exercise? Or was I just lucky for those 5 years I was in great shape? And, is most of this in my head? or is this something that is very serious, and life threatening if I exercise heavily? I guess I don't really care anymore, I'd rather die then live and fear going to the theme park and go on a ride just in CASE my SVT starts while on the coaster.....

[John2004]

Thanks much for your reply.

By identifying vasovagal syncope you helped me to find this article - http://heartdisease.about.com/cs/arrhythmias/a/Syncope2_2.htm - which I find matches perfectly with my situation.  

Doctors here like to prescribe drugs for everything but I think since :
- this is quite common,
- is relatively benign and easy to prevent any serious result as I recognize the symptoms and so far always have had plenty of time to take "evasive actions"
- only happens to me once every 2-3 years
- I don't like the sideeffects of the beta blocker drugs

I think I will suggest the doctor to discontinue drug treatment for this.  Do you agree?